AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Chondral Injury_ Small (_2cm) Fixation, Drilling and Biologics-Michael J. Alaia, M.D.

Chondral Injury_ Small (_2cm) Fixation, Drilling and Biologics-Michael J. Alaia, M.D.

Pdf Summary

This presentation by Dr. Michael J. Alaia (Feb 2020) focuses on the management of small chondral lesions in the knee, emphasizing individualized treatment strategies based on multiple factors such as symptom correlation, patient age, smoking status, BMI, activity level, and lesion characteristics including subchondral bone involvement.<br /><br />Key considerations in treatment include evaluation of limb alignment, meniscus and ligament status, and the osteochondral unit integrity. Surgical options range from debridement of symptomatic chondral flaps, which provides immediate symptomatic relief, to microfracture (MFX) and enhanced microfracture techniques ("microfracture plus") with augmentation by hyaluronic acid (HA), platelet-rich plasma (PRP), and scaffolds like AMIC and chitosan. However, traditional microfracture outcomes improve function short term (up to 2 years) but decline thereafter due to fibrocartilage formation, which is less durable.<br /><br />Newer microfracture techniques employ smaller, non-threaded K-wires to minimize subchondral bone damage and reduce complications such as bony overgrowth. The use of tailored technical approaches such as well-shouldered lesions and careful removal of calcified cartilage layers help stabilize repair tissue.<br /><br />For deeper or subchondral bone-involved lesions, osteochondral autograft transplantation system (OATS) and osteochondral allografts (OCA) provide hyaline cartilage with superior durability. OCA shows about 85% survivorship at 10 years, even in cases where microfracture has failed. The presentation highlights technical aspects of grafting and the patella as a special site, preferring matched patellar allografts to better approximate bone-to-cartilage ratios.<br /><br />Overall, microfracture alone has high failure rates; thus, selection of surgical technique must consider defect size, depth, and underlying bone marrow edema. Preoperative alignment films and meniscus preservation are critical to successful outcomes. The talk underscores cautious surgical intervention to avoid exacerbating lesions and advocates for using advanced grafting techniques for durable cartilage restoration in small chondral defects.

Keywords

small chondral lesions

knee cartilage repair

microfracture technique

enhanced microfracture

osteochondral autograft transplantation system (OATS)

osteochondral allografts (OCA)

subchondral bone involvement

hyaluronic acid augmentation

platelet-rich plasma (PRP)

meniscus and ligament evaluation